Update YOUR Plate:How to Choose a Healthy

Eating Plan

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Your moderator…Randy Querin

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Your speaker…

Jendy Newman, RD, CDE– Dietitian & Diabetes Educator– 25 years providing nutrition counsel– Roots in Ohio and Southeast Alaska– Oregon State University graduate– Loves to cook, garden and kayak

You’re not alone…

https://www.cnpp.usda.gov/hei-scores-americans

4 Keys to Healthier Living1. Not smoking2. Not being obese3. Getting 30 minutes exercise daily4. Eating healthier (more fruit/veggies, whole grains, less meat)

Follow these and we may wipe out:90% diabetes risk80% heart attack risk50% stroke risk33% cancer risk

Not following these guidelines accounts for 78% of chronic disease risk in U.S.https://nutritionfacts.org/topics/standard-american-diet/

Quest can be Overwhelming

What will healthier look like for you?Will any of these eating styles help you get there?

Today we will… Self reflect on your current eating style & health goal Be a critical consumer of nutrition information Explore diets to be cautious about & why Review 5 top-rated healthy eating styles Begin creating YOUR long-term healthy eating style Share resources to assist with YOUR action plan

Poll: What’s your main motivation?– Lose weight– Prevent or manage a chronic disease (cardiac, diabetes, cancer) – Tease out a gastrointestinal intolerance– Fuel a sport or high-energy need activity– Other (type in chat)

Self reflection/assessment How did I get to current weight or health situation?

Or what do I want to prevent? What changes have I tried in past? What did and didn’t work,

were they balanced, could I stick to plan for long term? What got in my way? Who can support me? How would I need to set myself up to be successful? How can I be kind to myself and set realistic goals/ plans?

Check with your health care provider

Big Picture Guidelines:1) Follow a healthy eating pattern across your lifespan.2) Focus on variety, nutrient-dense foods & amount.3) Limit calories from added sugars & saturated fats.4) Reduce sodium intake.5) Shift to healthier food & beverage choices.6) Support healthy eating patterns for all in household.

Consider shifting energy from counting calories & grams of macro’s to practicing mindfully eating real food in healthy portions.

Poll: Where do you get your nutrition news?– Major news outlets (tv, online, magazine)– Government nutrition sites– Diet programs– Family and friends– Other (type in chat)

How to Find Reliable Health Info Internet: Best = .edu, .gov, or .org; with caution = .com or .net Books, newspapers & magazines: Check author’s

qualifications (MD, RD, CDE, etc.), should be from accredited university or belong to credible organizations

TV: Make sure well-researched and repeatable study In General:

– Current & referenced with cited sources– Seek out multiple perspectives– Caution if advertising or selling a product

Hierarchy of Scientific Evidence

Increasing strength

Decreasing bias

https://www.foodinsight.org/sites/default/files/pictures/IFIC%202013%20FNCE%20Brochure%20-%20Evaluating%20Evidence%20-%20Web%20Version.pdf

Nutrition Science Updates

Quality matters more than quantity– Focus on dietary quality vs just counting calories or carbs or fat

grams Healthy Low Energy Density helps with weight loss & Diet

Quality:– Detailed 5-min video: https://nutritionfacts.org/video/eating-more-to-weigh-less

Is a Calorie a Calorie regardless of the source?– Carbohydrate Insulin Model

Energy Density: Which 100 calories makes you feel fuller?Carbohydrate 4 calories/gram Protein 4 calories/gram Fat 9 calories/gram Alcohol 7 calories/gramSugar, 2 Tablespoons

1 medium apple

5 cups raw broccoli

4 oz. red wine

2 ¼ oz. turkey

1 ¼ large egg

8 oz. beer (5% alcohol)

1 ½ oz. 80 proof spirits

2 ½ tsp. oil

¼ avocado

Peanut butter, 1 tablespoon

Dietary Quality

Whole grains council https://wholegrainscouncil.org/whole-grains-101/whats-whole-grain-refined-grain

Is a calorie still a calorie? Some of the factors that affects metabolism?

– Amount lean body mass (more muscle burns more calories)– Hormones (thyroid, insulin, glucagon, epinephrine, glucocorticoids)

– Gut microbiome (subject for another talk)

Carbohydrate Insulin Model– Food quality & balance of macro-nutrients in a meal matter– Highly processed carbs increase fat storage & increase hunger

due to the fact they cause excessive release of insulin

Reduces insulin resistance that promotes diabetes

Reduces inflammation that can promote heart disease

May improve your metabolic rate

Reducing added sugar

Poll: What kind of diet has worked for you?– Vegetarian/vegan– Mediterranean– High protein or high fat (paleo, keto, atkins) – Weight Watchers– Pre-packaged foods (e.g., HMR)– Other (type in chat)

US News & World Report Annual Best Diet Review Ninth annual assessment Scores 41 popular diet plans across 7 categories to help

Americans achieve healthier lifestyles Scores used to construct nine sets of rankings:

1. Best Overall2. Best Commercial3. Best Weight-Loss 4. Best Diabetes 5. Best Heart-Healthy6. Best for Healthy Eating7. Easiest to Follow8. Best Plant-Based9. Best Fast Weight-Loss https://health.usnews.com/best-diet

Scoring Categories1. Short-term weight loss. Likelihood of losing significant weight during the first 12 months, based on available evidence2. Long-term weight loss. Likelihood of maintaining significant weight loss for two years or more, based on available evidence3. Diabetes. Effectiveness for preventing diabetes or as a maintenance diet for diabetics 4. Heart. Effectiveness for cardiovascular disease prevention and as risk-reducing regimen for heart patients5. Ease of compliance. Based on initial adjustment, satiety (a feeling of fullness so that you'll stop eating), taste appeal, special requirements 6. Nutritional completeness. Based on conformance with the federal government's 2015 Dietary Guidelines for Americans, a widely accepted nutritional benchmark 7. Health risks. Including malnourishment, specific nutrient concerns, overly rapid weight loss, contraindications for certain populations or existing conditions, etc.

Scores could not be assigned to the cost of a plan, nor to exercise.

#1-5 used this rating scale: 5 = extremely effective, 4 = very effective, 3 = moderately effective, 2 = minimally effective, 1 = ineffective.

#6 used this rating scale 5 = extremely complete, 4 = very complete, 3 = moderately complete, 2 = somewhat complete, 1 = extremely incomplete.

#7 used this rating scale: 5 = extremely safe, 4 = very safe, 3 = moderately safe, 2 = somewhat unsafe, 1 = extremely unsafe. https://health.usnews.com/best-diet

5 Trendy Diets or Styles to Approach with Caution

1. Ketogenic2. Atkins3. Paleo4. Intermittent Fasting5. Low FODMAP

Healthy Approach "People are so desperate to lose weight that it's really weight

loss at any cost…(When desperation sets in) normal thinking goes out the window."

“Who cares how wacky or unhealthy a recommendation sounds to you? Pounds are coming off. You're happy. But your body might not be. And that approach always guarantees weight regain.”

– Madelyn Fernstrom, founding director of University of Pittsburgh Medical Center Weight Management Center

As quoted in US News and World Report

Extreme plans typically not okay for:

Children and youth Women who are pregnant or breastfeeding Individuals

– On diabetes medication (some exceptions for new type 2 diabetes)

– With eating disorders– With advanced kidney disease– On certain medications that need routine, balanced diets

Discuss your situation and plan with your healthcare provider or dietitian before making major dietary changes

1. Ketogenic Diet – 38th overall What: Very low carb (5-10%) 20-50 gm (usually net) carb/day,

very high fat (70-80%), modest protein (10-20%)– Started 1920’s to treat medication resistant epilepsy in children– Used as fast weight loss diet

Claims: shift to using fats for ketones as main fuel source to lower circulating insulin levels to promote weight loss. You feel full and may eat fewer calories and improve blood sugars.

Ranking: 41st Healthy Eating, 24th Diabetes, tie for 2nd in Best Fast Weight Loss

https://health.usnews.com/best-diethttps://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/ketogenic-diet/

Ketogenic Concerns Hard to maintain a very high fat diet Significant loss water weight initially as your use up stored glucose in

muscle, you will regain that weight when restart eating some healthy carbs Unpleasant symptoms days to weeks: hunger, fatigue, low mood, irritable,

constipation, headache, brain fog, bad breath Increased risk kidney stones, osteoporosis, gout, risk nutrient deficiency

(fiber, b’s, iron, magnesium, zinc) Never safe for kidney disease, pregnancy, breastfeeding, children,

adolescents, EDO, Type 1 diabetes. Inadequate carbs for high energy sports

Little known of long-term safety compared to low fat weight loss or Mediterranean weight loss diets

Ketos weight loss benefit seems to disappear over time

2. Atkins Diet – 37th overall What: Low carb diet (20, 40 or 100 gm net carb per day) used for fast

weight loss Claims: similar to Keto especially for first 2 weeks on Atkins 20 or 40.

Lose weight, improve insulin resistance and improve lipid levels Ranking: 39th for Healthy Eating, 37th in Heart-Healthy, tied for 2nd in

Best Fast Weight Loss. Concerns:

– Difficult to stick with, high in total & saturated fat, difficult to do for long term, expensive, inadequate carbs for high energy sports

– not safe in: pregnancy, youth, people with diabetes on medications, caution with kidney disease

https://health.usnews.com/best-diethttps://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/atkins-diet/art-20048485

3. Paleo – 26th-37th rankings What: a high protein “caveman” diet based on meat, fish, poultry,

fruit and vegetable available pre-agriculturally Claims: by eliminating modern-era processed food, whole grains,

dairy, legumes, alcohol, coffee, salt, refined oils hope to avoid type 2 diabetes/ heart disease and lose weight; you feel full and may eat fewer calories

Ranking: Low rankings 26th-37th of 41 in all categories. Concerns:

– harder to follow, costly, inadequate carbs for high energy sports, risk for deficiency in calcium, vitamins D and B

– Significant regional differences in diet world wide

https://health.usnews.com/best-diethttps://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/paleo-diet/

Want to try Lower Carb Plan?

Check out the impact of dietary quality on athletic performance: https://nutritionfacts.org/video/the-gladiator-

diet-how-vegetarian-athletes-stack-up/ https://nutritionfacts.org/video/the-first-

studies-on-vegetarian-athletes/

Very low carb or high protein diets may not be best for athletic performance

4. Intermittent Fasting for Weight Loss – not ranked What: Different versions

– Alternate day fasting down to 25% calorie needs (300-500 calories for many) with no food restrictions

– Whole-day fasting 1-2 days per week, complete fasting or up to 25% calorie needs– Time-restricted eating (meals only between 8 am – 3 pm)

Claims: propose that stress from the plan causes immune response to repair cells making it increase lifespan and promote positive metabolic changes to lipids, weight, glucose and others

Ranking: not ranked by US news and world report Concerns:

– not enough research in humans; impact to families of kids seeing the parents meal skipping

– Not safe for: pregnancy, youth, people with diabetes on medications, kidney disease, eating disorders, certain Rx medications

https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/intermittent-fasting/

5. Low FODMAP – not ranked What: an elimination diet that helps tease out food intolerance with digestive

problems. – Removes wheat, rye, lactose, certain fruits and vegetables, certain fibers, high

fructose corn syrup and sugar alcohol based artificial sweeteners. – After 2-6 weeks begin reintroducing foods one at a time in increasing amounts to

determine tolerance. – Then develop list of foods to limit or avoid to control gut symptoms.

Claims: limiting certain types of carbs that could be poorly digested & absorbed vastly improves symptoms of IBS such as bloating, gas and abdominal pain.

Ranking: not ranked by US News and World Report Concerns:

– Only for people ready to work on teasing out food intolerances– Do with help of RD familiar with FODMAP diet and a good FODMAP

cookbook. If don’t do re-introductions, you risk nutrition deficiencies.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5390324/

Low FODMAP handout

https://patienteducation.osumc.edu/documents/lowfodmapdiet.pdf

5 Best Ranked Diets 2019Top 5 Best Overall Diets1 Mediterranean2 DASH3 Flexitarian4 (tie) MIND & Weight Watchers

Most commonly in top 5Mediterranean (#1 in 6 of 9)Flexitarian (6 of 9)Weight Watchers (6 of 9)DASH (5 of 9)MIND (4 of 9)

https://health.usnews.com/best-diet

Healthy Eating Pattern INCLUDES: Variety of vegetables from all subgroups…dark green, red &

orange, beans & peas, starchy & other Fruits, especially whole Grains (=/>half whole grains) Fat-free or low-fat dairy, milk, yogurt, cheese &/or fortified soy

beverages Variety of proteins, seafood, lean meats & poultry, eggs, beans

& peas, nuts, seeds & soy products Oilshttps://health.gov/dietaryguidelines/2015/guidelines/executive-summary/#guidelines

Healthy Eating Pattern LIMITS: Added sugars (<10% of calories per day) Saturated fats (<10% of calories per day) Sodium (<2,300 milligrams per day) If alcohol is consumed, it should be in moderation

– up to one drink per day for women – up to two drinks per day for men– only by adults of legal drinking age

Am Heart Assochttps://health.gov/dietaryguidelines/2015/guidelines/executive-summary/#guidelines

What do Top 5 Diets have in Common?In: whole foods plant-based foods

(veg/fruit/whole grains legumes, nuts, seeds, oils

lean protein in modest amounts mostly fish, poultry, dairy, eggs (limited yolks)

nutrition balance/density and developing lifelong eating style

not feeling hungry just after a mealInitially may take more time to plan & prep, but with practice, smart shopping, planned leftovers and smarter dining out choices are very do-able

Out: processed and salty foods red meat, especially high fat animal fats (saturated) and Trans fats

(hydrogenated) excess sweets and sweet beverages restrictive diets that leave you feeling

hungry and focused on food extreme diets that omit healthy food

groups and are hard to stick to for long term

When it comes to diet, everything old is new again

1. Mediterranean- #1 Best OverallWhat: Eating pattern based on people of Crete, Greece & Southern Italy mid-20th century with long life expectancy despite limited healthcare.

Emphasizes: mainly fruits and vegetables, beans, nuts, whole grains, fish/seafood, olive oil, water as primary beverage, small amounts of dairy(especially cultured) & may include small amounts of red wine. Plus social connection and physically active lifestyle

Limits: red meats and sweets

Benefits: balanced & can be followed long term. Promotes weight loss, decreased risk diabetes/ heart disease/ heart attack or second heart attack, improved blood pressure & blood cholesterol, nurtures healthy babies & may slow memory loss.

https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/mediterranean-diet/https://oldwayspt.org/traditional-diets/mediterranean-diet

Watch webinar for more how to’s:peacehealth.org/food-medicine

Eating Well’s 7 day Mediterranean menus 2000-calorie menu

http://www.eatingwell.com/article/288739/7-day-mediterranean-meal-plan-2000-calories/

1,500-calorie menu http://www.eatingwell.com/article/288737/7-day-mediterranean-meal-plan-1500-calories/

1,200-calorie menu http://www.eatingwell.com/article/288560/7-day-mediterranean-meal-plan-1200-calories/

2. DASH- #2 Best OverallWhat: Dietary Approach to Stop Hypertension

Emphasizes: fruits, veggies, whole grains, lean protein, legumes, fish & low-fat dairy. high in blood pressure-deflating potassium, calcium, magnesium, protein & fiber. Low in saturated fat, buy lowering fatty meats, full-fat dairy foods & tropical oils, as well as

sugar-sweetened beverages and sweets. Caps sodium at 2,300 milligrams a day, which followers will eventually lower to about 1,500

milligrams.

Benefits: balanced & can be followed long term; lowers blood pressure & bad LDL cholesterol & helps increase good HDL cholesterol; can lower BP within 2 weeks and eventually lower systolic BP as much as 8-14 points

Two additional versions: substitutes 10% of carbs with extra protein or unsaturated fats which can further lower blood pressure, decrease LDL & triglycerides & reduce cardiovascular risk

https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/dash-diet/https://health.usnews.com/best-diet/dash-diet/health-and-nutrition

3. Flexitarian - #3 Best OverallWhat: semi-vegetarian/vegan, but allows you to choose meat occasionally. Work into it gradually.

Emphasizes: gradual changes to less meat and more plant foods and allows for flexibility and skill building.

Benefits: similar to benefits of vegetarian- reduce weight, longer life, lower risk heart disease, diabetes and cancer but easier to follow.

Recommend: balanced multiple vitamin for your age to stay on long term. Avoid bingeing when have your meat/poultry/fish days.

https://www.hsph.harvard.edu/nutritionsource/healthy-weight/diet-reviews/dash-diet/https://health.usnews.com/best-diet/dash-diet/health-and-nutrition

4. & 5. (tie) MIND-#4 Best OverallWhat: Mediterranean-DASH Intervention for Neurodegenerative Delay

Combo of Med & DASH with focus on foods may lower risk of mental decline.

Emphasizes: minimum servings of green leafy veg (>=1/day), berries >= 2/wk, nuts >= 5/week, legumes>= 5/week, whole grain 3/day, seafood >= 4-6 oz/week, poultry 2/week, olive oil 1 TBSP/day, wine up =<5 ounce/day

Limits: red meat, sweets, solid fats, full fat cheese, fried and fast foods

Benefits: balanced & can be followed long term

MIND diet lowered Alzheimer's risk by 35 percent in those who followed it moderately well and 53 percent for those who adhered to it rigorously.

5-year NIH study underway to understand long-term impact of the diet; research team notes it is superior to DASH and Mediterranean diets for preventing cognitive decline.

https://www.health.harvard.edu/mind-and-mood/a-personalized-approach-to-preventing-alzheimers-diseasehttps://health.usnews.com/best-diet/mind-diet

4. & 5. (tie) Weight Watchers -#4 Best Overall #1 Best Weight Loss/CommercialWhat: WW “Wellness that Works” Nationwide commercial plan digital-only experience, meetings or personal coaching subscription. Uses a point system that allows you to use points for higher calorie foods however you like.

Emphasizes: healthy lower calorie foods with fruit, veggies and 200 other foods that are 0 points, including eggs, corn, fish, seafood, skinless chicken or turkey breast, non-fat plain yogurt, beans, peas, lentils and tofu. Steers away from foods higher in sugars and saturated fats. Plus behavioral management techniques that help with permanent weight loss

Benefits: good for anyone, great for people with high blood pressure, high cholesterol, diabetes, and even heart disease; helps prevent and manage diabetes in 6-12 month studies; reduces LDL and triglycerides. reduces ratio of LDL cholesterol to HDL

https://www.webmd.com/diet/a-z/weight-watchers-diethttps://health.usnews.com/best-diet/weight-watchers-diet

Poll: Which diet sounds right for you?– Mediterranean– DASH– Flexitarian– MIND/Weight Watchers– Other (type in chat)

Bonus: Best Fast Weight Loss#1 HMR

nationwide weight loss program with medically supervised, in-clinic or at-home options & pre-packaged food

PHSW offers medically supervised/in-clinic & performs very well among other programs

3x as much weight is lost and kept off using meal replacements, compared to traditional diets, experts say

Encourages physical activity and teaches behavioral management techniques

#2 (Four-way tie) Atkins, Keto, Optavia (Medifast), Weight WatchersBut note that Atkins and Keto got low scores on being healthy!

https://health.usnews.com/best-diet

“Handy” Portion Control

Oils: 1 thumb or thumb tip

Veggies: 1-2 fists

Fruits: ½ to 1 fist fruit or save for a snack

9 inch plate or smallerNo bigger than 2 open hands laid flat

Beverage: 1 fist water or healthy beverage choice

Whole grains or starchy veggie: ½ to 1 fist

Healthy Protein:Up to 1 palm

Keep in Mind Try not to be too rigid (try 80/20 rule). Fit healthy into your lifestyle & tastes so you

can stick with it. Quality matters. Proportions/portions matter. Go for variety of colorful foods. Avoid hidden sources of fats, sugar and sodium (= “processed”). Ask your healthcare provider if you need certain supplements. Be mindful about ALL food choices (at home, eating out, while shopping). Ask for help to adopt and stick to healthier eating habits. Cook your own food more often.

What will Healthier Look Like for You? Include higher ratio of healthy nutrient-rich foods Plan quick simple meals so you can eat out less Reduce unhealthy foods Adjust meal frequency/timing Reduce portions Better beverage choices Be more active Get better sleep

Take Action to Shift to Long-Term Eating Style Self Assess and evaluate the options Decide what works best for YOU

Go slowOr Go big

Ask for help to stay on track You need

– Simple plan– Way to track progress– Re-assess regularly and tweak or challenge yourself

Resources & HandoutsAvailable at: peacehealth.org/healthy-eating-plan Recording available soon Download

Presentation slides Overview handout & Resource List Top three diet summaries Weight loss worksheet

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